Abstract
BackgroundPeople living with HIV (PLHIV) who are also marginalized by social and structural inequities often face barriers to accessing and adhering to HIV treatment and care. The Dr. Peter Centre (DPC) is a non-profit integrated care facility with a supervised injection room that serves PLHIV experiencing multiple barriers to social and health services in Vancouver, Canada. This study examines whether the DPC is successful in drawing in PLHIV with complex health issues, including addiction.MethodsUsing data collected by the Longitudinal Investigations into Supportive and Ancillary health services (LISA) study from July 2007 to January 2010, linked with clinical variables available through the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program, we identified DPC and non-DPC clients with a history of injection drug use. Bivariable and multivariable logistic regression analyses compared socio-demographic and clinical characteristics of DPC clients (n = 76) and non-DPC clients (n = 482) with a history of injection drug use.ResultsOf the 917 LISA participants included within this analysis, 100 (10.9%) reported being a DPC client, of which 76 reported a history of injection drug use. Adjusted results found that compared to non-DPC clients with a history of injection drug use, DPC-clients were more likely to be male (AOR: 4.18, 95% CI = 2.09–8.37); use supportive services daily vs. less than daily (AOR: 3.16, 95% CI = 1.79–5.61); to have been diagnosed with a mental health disorder (AOR: 2.11; 95% CI: 1.12–3.99); to have a history of interpersonal violence (AOR: 2.76; 95% CI: 1.23–6.19); and to have ever experienced ART interruption longer than 1 year (AOR: 2.39; 95% CI: 1.38–4.15).ConclusionsOur analyses suggest that the DPC operating care model engages PLHIV with complex care needs, highlighting that integrated care facilities are needed to support the multiple intersecting vulnerabilities faced by PLHIV with a history of injection drug use living within urban centres in North America and beyond.
Highlights
People living with HIV (PLHIV) who are marginalized by social and structural inequities often face barriers to accessing and adhering to HIV treatment and care
Multivariable results found that compared to those who were not Dr Peter Centre (DPC) clients, DPC clients were more likely to be male compared to female, to use supportive services daily (AOR: 3.16; 95% CI: 1.79–5.61), have been diagnosed with a mental health disorder (AOR: 2.11; 95% CI: 1.12–3.99), have a history of interpersonal violence (AOR: 2.76; 95% CI: 1.23–6.19), and to have ever experienced antiretroviral therapy (ART) interruption longer than 1 year (AOR: 2.39; 95% CI: 1.38–4.15)
This is aligned with our finding that DPC clients with a history of injection drug use are more than twice as likely to have been diagnosed with a mental health condition compared to their non-DPC client counterparts
Summary
People living with HIV (PLHIV) who are marginalized by social and structural inequities often face barriers to accessing and adhering to HIV treatment and care. The Dr Peter Centre (DPC) is a non-profit integrated care facility with a supervised injection room that serves PLHIV experiencing multiple barriers to social and health services in Vancouver, Canada. There are an estimated 3 million people living with HIV (PLHIV) who inject drugs [1, 2] Within these populations, issues such as delayed HIV testing, low uptake of antiretroviral therapy (ART), ART treatment interruptions, and the need for management of HIV and HIV-related opportunistic infections are pertinent issues [3]. The emergence of supervised injection facilities (SIFs)—locations in which PWID consume pre-obtained illicit drugs under staff supervision—aims to address these health-related challenges by providing sterile syringes to PWID, referrals to primary health services, and emergency care in the event of an overdose [5]. While there are demonstrated benefits of a specialized integrated approach to care for PLHIV who inject drugs based on need [6], previous research has not focused on the integration of harm reduction, including SIFs, into these health care environments
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